Medical MJ

[NJWxMan]

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I live and work in the liberal state of NJ and I'm seeing more and more patients demanding continuation of their medical marijuana (prescribed by past psychiatrists and PCP's) for treatment of ANXIETY. Anyone else struggling with this? I'm at a loss.

 

[VA Hopeful Dr]

Seems like a good time to remember grade school DARE: just say no.

 

[deleted480308]

I live and work in the liberal state of NJ and I'm seeing more and more patients demanding continuation of their medical marijuana (prescribed by past psychiatrists and PCP's) for treatment of ANXIETY. Anyone else struggling with this? I'm at a loss.

I never care what other docs prescribed. If I don't think it's appropriate, I don't. The most I will do is a "you don't die of withdraw" dose

 

[NJWxMan]

I never care what other docs prescribed. If I don't think it's appropriate, I don't. The most I will do is a "you don't die of withdraw" dose

I agree, but unfortunately, I'm made to be the withholding doctor not allowing access to care because I'm not open-minded.

 

[deleted480308]

I agree, but unfortunately, I'm made to be the withholding doctor not allowing access to care because I'm not open-minded.

Is it good care or not?

 

[hamstergang]

Thankfully our government has decided that dispensaries are essential businesses that will stay open while everything else shuts down during this pandemic...

 

[wolfvgang22]

I agree, but unfortunately, I'm made to be the withholding doctor not allowing access to care because I'm not open-minded.

Is there an employer putting pressure on you to keep patients happy? If so, this is what I do.

If your colleagues agree with you and aren't candy men, consult with them about the case briefly then document you did so and standard of care is to say no to inappropriate requests. If you feel any administrator may put pressure on you to prescribe a drug that could harm the patient, proactively document it is not safe and why. There is a lot of literature you can cite that reports cannabis can worsen mood, impair participation in therapy, cause psychosis, amotivation syndrome, weight gain, worsen lung function, etc. My go to answer to any administrator whenever a patient wants any drug of abuse or inappropriate treatment, whatever it is, is "It is not safe." I offer the patient a referral to another physician if they are unhappy with my care. If an employer gives you problems after that, you need to move on. If it is a private patient who continually wants to manipulate you into poor decisions, you need to terminate care and refer.

 

[Sushirolls]

Say no. Explain why. Emphasize that if they continue to use they need to lower their expectations of what pharmacotherapy can do. Secondly, counsel about the serotonergic properties of cannabinoids and potentially increasing risk of serotonin syndrome.

I'd rough estimate 20-33% of my cannabinoid patients continue to follow up after one visit. I had one stick around for several visits, and was consistently not making progress, as expected. The patient recently found another 'provider who is a better fit.' Those who do take the professional advice to quit, or slowly reduce, are making progress.

No to cannabinoids.

I wish cannabis were a panacea cure all treatment. I could quit psych, became a marijuana farmer and have a leg up on the competition because its Dr Recommended. But it's not. I've had some clinic days where 50% of my patients for the day was spent saying 'No cannabis, stop cannabis'.

 

[tr]

Legalization of recreational use solves this problem. Having practiced in CA before and after legalization, I much preferred the latter. It became possible to have a reasonable conversation about risks and benefits without the tension of them viewing you as a gatekeeper.

 

[heysexylady]

I live and work in the liberal state of NJ and I'm seeing more and more patients demanding continuation of their medical marijuana (prescribed by past psychiatrists and PCP's) for treatment of ANXIETY. Anyone else struggling with this? I'm at a loss.

In nj you need a separate license to prescribe. If you don't have one... Tell your pts you can't and if they continue to pressure you. Let them know they are free to return and continue care with the physician that originally Prescribed it.

They can't force you to do anything that you don't want to do. It's your license, Dea, and career..so your decision.

 

[Stagg737]

Legalization of recreational use solves this problem. Having practiced in CA before and after legalization, I much preferred the latter. It became possible to have a reasonable conversation about risks and benefits without the tension of them viewing you as a gatekeeper.

I'm relatively ambivalent about the legalization of recreational cannabis. Anecdotally I have seen an increase in cases of THC-induced psychosis in our ERs since our state legalized medical marijuana though. Would be interesting to see what the results of a national legalization would be.

 

[NJWxMan]

In nj you need a separate license to prescribe. If you don't have one... Tell your pts you can't and if they continue to pressure you. Let them know they are free to return and continue care with the physician that originally Prescribed it.

They can't force you to do anything that you don't want to do. It's your license, Dea, and career..so your decision.

Thank you. Agreed. Unfortunately, several community psychiatrists tell the patients "don't return to my practice until you complete IOP." I don't prescribe medical MJ. I just set the limit of no cannabis while in IOP, and it creates a firestorm. I also believe that most patients that are on medical MJ aren't really getting it from the dispensary, so they don't run out while attending iop.

 

[NickNaylor]

I agree, but unfortunately, I'm made to be the withholding doctor not allowing access to care because I'm not open-minded.

So? Who cares if patients think your open-minded or not? Your job is to recommend treatments that are likely to provide benefit and relatively unlikely to cause harm - or at least such that that balance is reasonable. If you don't think medical cannabis meets that threshold, that's all there is to it - you aren't obligated to prescribe or do anything that you don't think will be beneficial to the patient. I'm sure there are plenty of other physicians that will happy endorse the use of medical cannabis... for a fee.

 

[MLT2MT2DO]

I live and work in the liberal state of NJ and I'm seeing more and more patients demanding continuation of their medical marijuana (prescribed by past psychiatrists and PCP's) for treatment of ANXIETY. Anyone else struggling with this? I'm at a loss.

I'm curious what you'd do if the demanding Benzos or Opiates. You should never "be at a loss" when you have a patient "demanding something" and you sticking to your your ethics